Date: 04 February 1944
Cert: 04917
Place of Death: County: Knott City or
Town: Hindman, Ky. Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Hindman, Ky. Rural
Full Name: Infant DUTY (Not named)
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 04 February 1944
Age: 10 minutes
Birthplace: Hindman, Ky. Rural
Occupation: (blank)
Industry or business: (blank)
Father Name: John DUTY
Father Birthplace: West Virginia
Mother Maiden Name: Dorothy PERKINS
Mother Birthplace: Knott Co., Ky.
Informant: Dr. M. F. KELLEY, Hindman, Ky.
Burial Place: Hindman
Date: 05 February 1944
Signature of funeral director: Family, Hindman, Ky.
Date received by local registrar: 21 February 1944
Registrar's Signature: Ida Livingston
Date of Death: 04 February 1944
I hereby certify that I attended deceased from 04 February
1944 to
same day, that I last saw him alive on 04 February 1944, and
that death occurred on the date stated above at 7:10 p.m.
Immediate cause of death: (blank)
Duration: (blank)
Due to: Congenital debility
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: M. F. Kelley, M.D.
Date signed: (blank)
Transcribed by Debbie Tamborski, 12 November 2010 |